When Cannabis Meets the Dental Chair: Managing Clinical and Liability Risks - Julie Goldberg, DDS, CCDS August 2026 E NEWS

 

When Cannabis Meets the Dental Chair: Managing Clinical and Liability Risks

Author: Julie Goldberg, DDS, Professional Dental Risk Specialist at PMIG

As cannabis use becomes increasingly common across the United States, dental professionals are treating more patients who use marijuana for recreational or medical purposes. While legalization has reduced the stigma associated with cannabis, it has not eliminated the clinical and legal challenges it presents in the dental setting.

Cannabis can affect oral health, alter responses to local anesthetics and sedatives, impair a patient's ability to provide informed consent, and increase the potential for treatment complications. For dental practices, understanding these risks, and documenting clinical decision-making appropriately, can help improve patient safety while reducing professional liability exposure.

Cannabis and Oral Health

Cannabis affects the oral cavity in several ways that may complicate diagnosis, treatment planning, and long-term outcomes.

Xerostomia

One of the most common oral effects is xerostomia. Tetrahydrocannabinol (THC), the primary psychoactive component of cannabis, reduces salivary flow by interacting with cannabinoid receptors in the salivary glands. Reduced saliva increases the risk for dental caries, plaque accumulation, oral candidiasis, mucosal irritation and/or halitosis.

Patients who regularly use cannabis should be considered at elevated risk for dental disease and may benefit from enhanced preventive measures.

Periodontal Disease

Several studies have found an association between chronic cannabis use and increased periodontal inflammation, attachment loss, and poorer periodontal outcomes.

Increased Caries Risk

Cannabis users often report increased consumption of sugary foods and beverages following use. Combined with xerostomia, these dietary habits may accelerate caries development.

Delayed Healing

Emerging evidence suggests cannabis may impair immune function and inflammatory responses involved in wound healing. Although research continues to evolve, delayed healing following extractions or periodontal surgery should be considered when treatment planning.

Sedation and Anesthesia Considerations

Cannabis use presents important considerations for dentists providing sedation or anesthesia.

Altered Sedation Requirements

Patients who use cannabis regularly may require higher doses of sedative medications due to increased tolerance. Conversely, patients who are acutely intoxicated may respond unpredictably, placing them at greater risk for oversedation or inadequate sedation.

Cardiovascular Effects

Cannabis may cause:

• Tachycardia
• Orthostatic hypotension
• Increased myocardial oxygen demand

These physiologic effects can complicate sedation and increase cardiovascular risk during dental procedures.

Respiratory Concerns

Patients who smoke cannabis may exhibit airway irritation similar to tobacco smokers, increasing the potential for:

• Bronchospasm
• Persistent coughing
• Airway management challenges

Drug Interactions

Cannabinoids may influence hepatic enzyme activity, potentially affecting metabolism of commonly prescribed sedatives, opioids, and other medications. While clinically significant interactions vary among individuals, practitioners should recognize cannabis as a potential modifier of pharmacologic response.

Disclosure Challenges

Many patients underestimate or fail to disclose cannabis use unless specifically asked. Terms such as "occasionally" or "socially" often provide insufficient information for safe treatment planning.

Informed Consent and Decision-Making Capacity

Cannabis also raises important medicolegal considerations.

Acute intoxication may impair judgement, short-term memory, attention and/or decision-making capacity. These effects can compromise a patient's ability to understand risks, evaluate alternatives, and provide legally valid informed consent.

Patients who are intoxicated may also have difficulty remembering postoperative instructions, increasing the likelihood of noncompliance and poor outcomes.

Practical Risk Reduction Strategies

Dentists can reduce both clinical and legal risk by implementing consistent office protocols.

Strengthen Medical History Screening

Update health history forms to include questions about cannabis use, including:

• Medical or recreational use
• Frequency of use
• Method of consumption (smoked, vaporized, edible, tincture)
• Date and time of last use

Normalize these questions by asking every patient rather than targeting specific individuals.

Assess Before Every Sedation Appointment

Before administering sedation or anesthesia:

• Confirm the patient's most recent cannabis use.
• Evaluate for signs of intoxication, including impaired coordination, altered speech, delayed responses, or unusual behavior.
• Consider postponing elective procedures if impairment is suspected or recent cannabis use may increase procedural risk.

Modify Treatment Planning When Appropriate

Patients who regularly use cannabis may benefit from:

• More frequent preventive care appointments
• Prescription-strength fluoride therapy
• Saliva substitutes or products that stimulate salivary flow
• Additional periodontal monitoring
• Shorter appointments for anxious patients

Tailoring care to each patient's risk profile demonstrates thoughtful clinical judgment and supports defensible decision-making.

Reinforce Communication

Provide postoperative instructions both verbally and in writing.

For patients whose comprehension or memory may be affected, consider asking them to repeat key instructions to confirm understanding. When appropriate and with the patient's consent, involve a responsible adult in postoperative discussions.

Document Thoroughly

Documentation remains one of the strongest defenses against malpractice claims.

Record:

• The patient's reported cannabis use
• Timing of last use
• Clinical observations
• Assessment of decision-making capacity
• Any modifications to the treatment plan
• Informed consent discussions
• The rationale for proceeding with or postponing treatment

If treatment is deferred because of suspected impairment, document the specific observations that supported the decision.

Conclusion

Cannabis use is not an automatic contraindication to dental treatment, but it does introduce variables that can affect patient safety, treatment outcomes, and professional liability.

By incorporating cannabis screening into routine medical histories, carefully assessing patients before treatment, modifying care when indicated, and documenting clinical decision-making thoroughly, dentists can better protect both their patients and their practice.

As cannabis use continues to increase, proactive risk management will remain one of the most effective tools for reducing malpractice exposure.

 

This article is intended to provide general information only on certain risk management topics and is not intended to provide any coverage determinations or coverage positions, nor is it to be construed as providing legal, medical, or professional advice of any form.

 

References

American Dental Association. Cannabis: Oral Health Topics. https://www.ada.org

American Society of Anesthesiologists. Cannabis and Surgery: What Patients Need to Know.

National Institute on Drug Abuse. Marijuana DrugFacts. https://nida.nih.gov

Versteeg PA, Slot DE, van der Velden U, van der Weijden GA. Effect of cannabis usage on the oral environment: A review. International Journal of Dental Hygiene. 2008;5(1):1–8.

Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Australian Dental Journal. 2005;50(2):70–74.

Little JW. Dental management of the medically compromised patient. 10th ed. Elsevier; 2024.

American Association of Oral and Maxillofacial Surgeons. Clinical considerations for patients using cannabis undergoing office-based anesthesia. Clinical Paper. 2024.

 

Your Online Reviews Are Already Telling Your Story - The Digital Chairside Kayla Mauldin, August 2026 CCDS E News

 

The Digital Chairside

Marketing insights, explained like you'd explain treatment to a patient.

Your Online Reviews Are Already Telling Your Story—Are They Saying What You Want?

By Kayla Mauldin, Founder, Firelight Marketing
Former dental professional with over 23 years of experience in dentistry

Long before a patient walks through your front door, they're already forming an opinion about your practice.

They've searched Google. They've looked at your website. Maybe they've even visited your Facebook page.

Then they do something almost everyone does before making an important decision:

They read your reviews.

As dental professionals, we often think of reviews as ratings. Four stars. Five stars. The occasional negative comment.

Patients see something entirely different.

They're looking for reassurance.

Patients Aren't Looking for Perfection

Think about the last time you chose a restaurant, hired a contractor, or booked a hotel.

Did you only look at the overall rating?

Probably not.

You likely read several reviews looking for answers to questions that mattered to you.

Patients do exactly the same thing.

They're wondering:

• Will this office be gentle?
• Will anyone judge me because it's been years since my last cleaning?
• Are they good with children?
• Can they get me in quickly if I'm in pain?
• Is the staff friendly?
• Will they explain my treatment?

Those answers aren't usually found on your website.

They're found in the experiences shared by other patients.

Reviews Build Trust Through Stories

The most valuable reviews don't simply say:

"Great dentist!"

Instead, they tell a story.

"I was terrified to come in after avoiding the dentist for years, but everyone made me feel comfortable."

"They got me in the same day when I broke a tooth."

"The hygienist explained everything before she started."

These are the reviews that help future patients picture themselves having a positive experience.

They replace uncertainty with confidence.

That's far more valuable than another five-star rating without context.

Every Review Is Feedback

Reviews aren't just marketing tools—they're one of the best sources of patient feedback available.

Pay attention to the words patients repeat.

Do they consistently mention:

• Friendly staff?
• Gentle care?
• Clean office?
• Short wait times?
• Excellent communication?

Those recurring themes tell you what your patients value most.

They also reveal what makes your practice different.

If you notice recurring concerns, those are opportunities to improve—not reasons to become discouraged.

The goal isn't perfection.

The goal is continuous improvement.

Responding Matters More Than Many Practices Realize

Patients notice whether practices respond to reviews.

A thoughtful response—whether the review is positive or negative—demonstrates professionalism and appreciation.

For positive reviews, a sincere thank you reinforces the relationship.

For critical reviews, a calm and respectful response shows prospective patients that your practice listens, cares, and takes concerns seriously.

Remember, your response isn't just for the person who wrote the review.

It's for every future patient who reads it.

From the Front Office

During my years working in dental practices, I answered thousands of phone calls.

Very few people asked if we had five-star reviews.

Instead, they asked questions that revealed what they were really worried about.

"Is the doctor gentle?"

"I haven't been in years..."

"I'm embarrassed."

"Can you get me in today?"

Those conversations taught me something I'll never forget.

Patients don't choose a dental practice because it's perfect.

They choose the practice that makes them feel understood.

The reviews that describe kindness, patience, compassion, and clear communication often influence patients far more than a simple star rating ever could.

The Takeaway

Your online reviews are already telling the story of your practice.

The question is whether they're telling the story you want future patients to hear.

The most effective reviews aren't the ones that simply praise your work—they're the ones that help nervous patients feel safe enough to make the first phone call.

That's where trust begins.

---

Chairside Challenge

This month, read your ten most recent Google reviews.

Don't focus on the star ratings.

Instead, write down the words or phrases patients use most often.

Do they describe your team as "friendly," "gentle," "thorough," "kind," or "professional"?

Those recurring themes represent your practice's greatest strengths.

Now ask yourself one question:

Are those same strengths clearly reflected on your website, social media, and patient communications?

If not, you've just identified your next marketing opportunity—not by guessing, but by listening to your patients.

Letter from Larry Michael Over - August 2026 E News

  

Dear Coastal Cascades Dental Society,

It is with happiness and some sadness that I want to inform you of my upcoming retirement from my prosthodontic and maxillofacial prosthetic practice. It is hard for me to believe how fast these 33 years of private practice in Eugene have gone.

Having said that, I am honored to introduce Dr. Neddie Zakhariya to you. I will transition my practice to Dr. Zakhariya the beginning of September. She is a native of Portland and completed her dental training at the OHSU School of Dentistry. Dr Zakhariya completed a three-year prosthodontic residency at the University of Minnesota and a one-year maxillofacial prosthetic fellowship at UCLA.

I will continue to practice full time until mid-August. I am so very grateful to my many colleagues that have allowed me to assist in the care of your patients. These relationships that we have developed are priceless to me.

I look forward to introducing Dr. Zakhariya to you this Fall.

Thank you so very much,

Dr. Larry Michael Over

Adriana Reppell, DMD: A Recipe of Balance, Purpose, and Connections - August 2026 CCDS E News

 

Adriana Reppell, DMD: A Life Recipe of Balance, Purpose, and Connections

Dr. Reppell has found that a recipe for a fulfilling career includes balancing her professional dedication, commitment to service, and a vibrant personal life.

Like many dentists, Dr. Reppell found her future career path on a service trip. When she was 13, she accompanied her mom to Jamaica. During the trip, she taught children about oral hygiene and observed dentists' clinical work. “I just thought it was the most wonderful looking thing ever!”

Today Dr. Reppell enjoys working at Willamette Dental treating a diverse group of families. At Willamette Dental, she likes that they focus on evidence-based research to support treatment plans, emphasizing prevention and fluoride products to remineralize teeth at the earliest signs of cavities. When treating children, Adriana takes the opportunity to help educate parents, supporting the health of their whole family. A skill Adriana has that helps her manage her patients’ anxiety is her ability to determine through their personal cues if they are more comfortable in a conversational or quiet environment.  She can easily put tense patients at ease with relatable stories. Setting clear communication boundaries, such as a physical signal, gives her patients the control to ask her to stop if they need her to.

For Dr. Reppell, dentistry isn’t just a job but an opportunity for service. She believes that volunteer dental work is a great way to keep her passion for dentistry alive. It is important to Adriana to find opportunities to serve populations who have significant barriers to care. She volunteers for Medical Teams International on Mondays providing dental services on their local mobile dental van. She has also volunteered at local dental clinics with Caring Hands Worldwide. Last October, Adriana combined volunteering with her love for international travel, traveling to Africa to volunteer and making time to enjoy a safari!

Dr. Reppell’s advice to new dentists is to be open, personable, and unafraid to network. She prioritizes connections not only with her patients but also with people in her community, approaching life with curiosity and care for others. She can strike up conversations with strangers, and doing so has even helped her find a group of adventurous women who enjoy the same outdoor activities she does!

Originally from Illinois, Adriana came to Oregon with a craving for outdoor adventures and a passion for creative pursuits. On the weekends, you can find her paddleboarding, camping, or enjoying backpacking trips with friends. She also enjoys local art and theater exhibits and performances. She expresses herself with watercolor paintings. Dr. Reppell is a “foodie” who enjoys her time in the kitchen, experimenting with new recipes, meal planning, or whipping up sourdough pretzel bites on her day off. Cooking for her is truly another creative outlet. She even enjoys taking on the challenge of preparing a delicious meal with limited ingredients.

Here is Adriana’s favorite recipe for sourdough pretzel bites from amybakesbread.com:

https://amybakesbread.com/pretzel-bites-with-sourdough-discard/

Educational vs. Promotional Content by Kayla Mauldin Founder, Firelight Marketing - July 2026 CCDS E NEWS

 

Educational vs. Promotional Content: What Dental Patients Actually Respond To

By Kayla Mauldin, Founder, Firelight Marketing
Former dental professional with over 23 years of experience in dentistry

If you've ever wondered what to post on your practice's social media or website, you're not alone. One of the most common questions I hear from dental teams is, "What kind of content actually works?"

The answer may surprise you.

Many practices assume they should primarily promote specials, discounts, or reminders to schedule appointments. While there is certainly a place for promotional content, it's educational content that often creates the trust necessary for a patient to choose your practice.

Before someone becomes your patient, they are looking for confidence—not a coupon.

Patients Want Confidence Before They Want an Appointment

For many people, visiting the dentist comes with uncertainty. They may be nervous, embarrassed, worried about cost, or simply unsure of what to expect.

Educational content helps answer those questions before the first phone call.

Think about the questions your team answers every day:

• Does getting a crown hurt?
• How long does a dental implant take?
• What's the difference between a bridge and an implant?
• How often should my child have dental checkups?
• Why does my tooth hurt if I don't have a cavity?

Every one of those conversations can become a valuable piece of educational content.

When your practice consistently provides helpful information, patients begin to see you as a trusted resource—not just another dental office.

Promotional Content Still Has a Place

Promotional content isn't bad. It simply shouldn't be your entire strategy.

Examples include:

• New patient specials
• Teeth whitening promotions
• Holiday office hours
• Referral programs
• Community events
• New technology announcements

These posts are important because they keep patients informed about your practice.

The key is balance.

If every post is asking patients to schedule an appointment, the content begins to feel like advertising.

Instead, promotional content should complement educational content—not replace it.

What Educational Content Looks Like

Educational content doesn't have to be complicated.

Some of the best-performing content comes from the everyday expertise already inside your practice.

Consider sharing:

• Brushing and flossing techniques
• What happens during common procedures
• Signs that it's time to call the dentist
• Frequently asked questions from patients
• The connection between oral health and overall health
• Tips for children's dental care
• What to expect during a first visit

These topics help patients feel informed and reduce anxiety long before they walk through your doors.

Don't Forget to Show the People Behind the Practice

Education isn't limited to clinical topics.

Patients also appreciate getting to know the people caring for them.

Sharing moments like:

• Team birthdays
• Continuing education courses
• CPR recertification
• Staff appreciation events
• Community volunteer projects
• Office celebrations

helps patients see the human side of your practice.

These posts communicate something important: your team is invested in one another, committed to learning, and actively involved in the community.

That builds trust in ways that advertising alone never can.

A Simple Content Formula

If you're not sure where to begin, consider using this simple approach.

Aim for approximately:

• 60% Educational – Answer questions, explain procedures, offer oral health tips.
• 30% Practice Culture – Celebrate your team, community involvement, milestones, and behind-the-scenes moments.
• 10% Promotional – Share special offers, announcements, new services, or appointment availability.

This creates a social media presence that feels informative, authentic, and welcoming rather than overly promotional.

The Takeaway

Every piece of content should answer one simple question:

"Does this help a patient know us, trust us, or feel more comfortable choosing us?"

If the answer is yes, it's probably worth sharing.

Educational content establishes your expertise. Practice culture builds connection. Promotional content encourages action.

Together, they create a digital presence that reflects the same level of care patients can expect when they walk into your office.

If your last social media post is more than 60–90 days old, that may be the first impression a potential patient sees. A simple, consistent presence builds more trust than a perfectly curated one.

What vs How by Janette Douglas - Reprinted from November/December 2024 Coastal Cascades Dentist Society Newsletter

 

Dental Office Management Corner with Janette Douglas

What vs How

Job Descriptions and SOPs are both crucial tools for each team position. Are you aware of the differences and what the purpose is for each? One is “what to do”. The other is “how to do”.

Job descriptions spell out the actual duties. For instance, for the insurance coordinator, it will list "Process insurance claims daily" or "Follow up on insurance claims weekly". This allows the staff member to know what their specific job responsibilities are. It is also a key piece in accountability.

The SOP (Standard Operating Procedure) goes into detail about each of the duties in the job
description. It will list the steps on how to "Process insurance claims daily" and how to “Follow up on insurance claims weekly”. The purpose is that anyone can accomplish the task by following the SOP.

Ideally, there is cross-training going on in your office. These tools will save invaluable time to accomplish that. If you have an employee leave or they are out for an extended period, someone else can step in and get the job done. Whew, crisis averted!